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Texas rates for HCPCS A5514

For Diabetics Only Multiple Density Insert Made By Direct Carving With Cam Technology From A Rectified Cad Model Created From A Digitized Scan Of The Patient Total Contact With Patients Foot Including Arch Base Layer Minimum Of 3/16 Inch Material Of Shore A 35 Durometer (Or Higher) Includes Arch Filler And Other Shaping Material Custom Fabricated Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.99 / $35.04 / $39.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.36 / $35.51 / $47.35
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.50 / $38.40 / $43.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.11 / $76.43 / $160.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.74 / $25.74 / $28.88
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $40.56 / $54.08
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $744.88 / $744.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $35.60 / $35.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $35.60
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.78 / $253.09 / $256.88
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.32 / $269.32 / $405.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $47.30 / $54.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.65 / $49.75 / $54.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.60 / $39.77 / $54.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.99 / $25.99 / $44.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.23 / $31.36 / $39.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $54.08 / $54.08